As Barbara Wilson-Clay says, "Babies are born to breastfeed." They should be
able to do this from birth on. Why they don't is often a matter of
interventions in childbirth or right after (labor medications, separating
mom and baby, delivery methods, etc.).
I will try to be brief this evening and discuss some ways to get these
babies to latch and suck. First of all, babies have to rhythmically suck and
swallow many times in a row to transfer milk. Those sleepy, drugged babies
who suck 4-5 times and stop, long pause, before doing another pitiful 4-5
sucks are not pulling out much milk in all probability and therefore don't
really learn to breastfeed. They are not being rewarded for their efforts,
therefore the frustration -- and the weight loss.
When I worked as a hospital IBCLC, I watched all the babies closely and
discovered that it takes about 10 or more sucks in a row at first to
transfer the milk. In the Breastfeeding Atlas, it says active sucking
means10-30 sucks in a row before a short pause. This sucking burst must be
done over and over with short 3-5 second pauses. The next time you have this
kind of sleepy baby, latch him on and watch him suck. Count the bursts or
repetitions. Watch and see if the short bursts or repetitions satisfy the
baby. They usually don't. The Breastfeeding Atlas has photos of the baby's
body language at the breast, from tight fists at first to relaxed arms upon
satiation. Also, the eyes will open when the milk flow is good (this is for
most babies who aren't too drugged up).
What I found as a hospital LC was that many of these sleepy babies needed
some help learning to actively suck at the breast. We used a small tipped
syringe (no needle) or a #5 French feeding tube on a 20 ml syringe with the
tube cut off just above the holes so you just have the one tube hole, not
all the side holes. This is used at the breast, a good squirt into the
corner of baby's mouth while latched onto the breast to make the baby start
swallowing which triggers the sucking reflex. You have to keep doing this
until baby has filled the tummy and squirt enough to make baby do long
repetitions. I normally used 10-15 ml total per feeding, divided between the
two breasts.
I find that most babies need to do this active sucking for at least ten
minutes, followed by another 5-10 minutes of comfort sucking at each breast
(the short burst of repetitions). They should fill up enough to come off the
breast by themselves. Moms with an abundant milk supply or a quick MER will
often suck less but with more gulping noises.
Now, no flames, where I worked the babies would be getting bottles if they
were not nursing well, so it was formula no matter what. I felt that at
least getting it at the breast encouraged baby to learn to suckle actively
and effectively. Rather than letting baby "pacify" at the breast and then
get a bottle. By day 2-3, most babies were nursing well after using this
method.
Another good intervention is having baby unwrapped down to the diaper and
put on mom's naked chest with blankets around the two of them. Let baby
awake to mom's scent and at her breast. Breast compression and massage help
keep the milk flowing, especially once the milk supply increases.
The sad thing about it is most hospital workers/physicians think these
sleepy, non-latching or sucking babies are NORMAL.
Kathy Eng, BSW, IBCLC
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